Monday, April 27, 2009

Building Academic Partnerships in Health with India

Harvey Skinner

York University’s new Faculty of Health has an ambitious mission to be an integrative force for promoting health – locally and globally. Communities of interest to the Faculty of Health are not only those of York’s immediate neighbours. The University has a keen interest in global issues fuelled by our location in a microcosm of the world - Ontario’s York Region - which is reflective of global diversity with a 46% immigrant population


Founded in 2006, the new Faculty consists of four units encompassing Health Policy & Management; Kinesiology & Health Science; Nursing and Psychology. Also, planning is well underway for a York Medical School. We have almost 9,000 students and approximately 400 faculty members (177 full time; 227 part-time). Through exceptional education and research, the Faculty emphasizes effective approaches for keeping more people healthier longer and creating sustainable healthcare systems.

In January 2008, I traveled to India. I had several goals in mind including identifying common interests and opportunities, building academic partnerships with leading institutions in India, and connecting these with York University and the Indo-Canadian community. A key liaison to this community was through York’s existing relationships with the Kurian family: Ms Kuttimol Kurian sits on the University’s Board of Governors and Dr.Joseph Kurian is President and CEO of Alpha Laboratories.

During the first week, time was spent with President Momdouh Shoukri and Dezso Horvath, dean of Schulich School of Business, exploring opportunities in Delhi (AIIMS: All India Institute of Medical Sciences, Public Health Foundation of India, Jawaharlal Nehru University), Mumbai (Schulich-India Initiative) and Pune (University of Pune). During the second week, time was spent with Ms Kuttimol Kurian and Dr. Joseph Kurian visiting institutions in Jaipur (Rajasthan University of Health Sciences) and Chennai (Christian Medical College, Vellore).

Why India, Why Now

My first impression upon landing in India was one of being “overwhelmed”. People everywhere, traffic jams that stretch across a whole city, vibrant energy, the sights and smells, poverty intermingled with wealth – all of these assault ones senses. There is no question that India is on the move and is experiencing a major economic boom. Moreover, India has a potential “demographic advantage” of 1.1 billion people (and growing) who could provide an ‘endless’ workforce and market. The great challenge is for this new prosperity to have benefits for the whole nation.

However, the incredible economic boom underway in India is encountering a major hitch

There is a growing shortage of well-trained professionals underscoring the need for human resource development.

There are major gaps in infrastructure support that need concerted attention such as: transportation, housing, power and water.

Maintaining the health of the workforce will be a challenge due to the rise in chronic disease (e.g. diabetes), pollution, stress (mental health) and access to health services (prevention and medical care).

There is concern that the gap between the “two Indias” (300 million middle class versus 800 million poor) will widen, with the prospects of social unrest and political instability that would undermine economic growth.

Two Indias

It is useful to think of two Indias. One is composed of approximately 300 million middle class that is growing fast and is a major engine fuelling the new economy. In contrast, the other India has approximately 800 million who are poor, including in the order of 300 million living in abject poverty (slums). Nearly three quarters of the population live in rural areas and an estimated 27.5% were living below the national poverty level as of 2004. Some 300 million people in India live on less than a dollar a day, and more than 50% of all children are malnourished.

The need for breakthrough thinking is captured in the best selling book by C.K. Prahalad entitled “A Fortune at the Bottom of the Pyramid”. Indeed, while we were in India, TATA Motors launched with great excitement around the world their new automobile call the “Nano”. TATA Motors is using a number of innovative solutions to produce an automobile at the low price of $2500. This is a significant change from the lowest cost car in India and elsewhere in the world. But, what will this new lower entry automobile do for a country that is already extremely congested?

Health Needs and Opportunities

Regarding healthcare, India provides high quality medical care to the middle class and medical tourists. This contrasts with the India in which the majority of the population lives where residents have limited or no access to health care. Only 25% of the Indian population has access to western medicine, which is practiced predominantly in urban areas. Only 11% of the population has any form of health insurance coverage. It is estimated that 20 million people in India fall below the poverty line each year because of indebtedness due to healthcare needs.

India is threatened by a ‘double whammy’ of both infectious and chronic diseases. While some infectious diseases such as leprosy have been eliminated, other communicable diseases thought to be under control have returned in force and some have developed resistance to drugs: e.g. dengue fever, tuberculosis, malaria and pneumonia. This troubling trend is attributed in part to substandard housing, pollution, inadequate water, sewage and waste management systems. As Indians live more affluent lives they are adopting unhealthy western diets that are high in fact and sugar. Hence, India is experiencing a rise in chronic diseases such as hypertension, cancer and diabetes. Indians seem more vulnerable to Type II diabetes. in the 1970’s 2.1% of Indians had diabetes whereas today the figure is 12.1% for adults over age 20.

Medical tourism is one of the major external drivers of growth in the Indian healthcare sector. India provides ‘best in class’ treatment in many cases at less than one tenth of the cost incurred in US. For example a liver transplant in the US cost approximately $500,000, whereas in India it costs $45,000.

India faces a huge shortage of trained health personnel including doctors, nurses and paramedics. There are immediate opportunities to participate in capacity building of both health personnel and health services (both medical care and public health).

This is where the opportunity lies in working with India for fulfilling the global health vision of the Faculty of Health.

Partnership with Rajasthan in a Centre of Excellence for Healthcare

Dr. Kurian, Ms Kurian and I met with Dr. P.P.S. Mathur, the Vice-Chancellor of Rajasthan University of Health Sciences and eight senior faculty members in medicine and nursing. Also, we toured the main teaching hospital and medical laboratories. In our discussions it became clear that a joint effort would yield a win-win result. We decided to establish the Canadian Centre of Excellence for Healthcare in Jaipur. This would be an academic-public-private partnership involving the State of Rajasthan Ministry of Health, Rajasthan University of Health Sciences, Faculty of Health at York University, the Michener Institute (Toronto) and Alpha Laboratories.

Just half a year later, on July 9, 2008 we came together, this time in Canada. The reason was to formally sign several memoranda of understanding in the areas of mutual academic interest. The Rajasthan Health Ministry wants to partner with Alpha Corporate Group in establishing a state-of-the-art medical laboratory center that will also serve as a significant teaching site in collaboration with the Rajasthan University of Health Sciences. The aim is to raise standards and achieve international accreditation in medical laboratory professional training. York University’s Faculty of Health and the Michener Institute, Toronto will collaborate on academic aspects (training, research) with the Rajasthan University of Health Sciences (RUHS). Also, this collaboration with RUHS will provide York University with opportunities to develop joint programs in health leadership, nursing and related health sciences as part of the Faculty of Health’s global health priority.

This partnership will bring under one umbrella the expertise from academia and the private sector to achieve the goals of establishing a world-class Centre at the forefront of health education and technology and will focus on infrastructure development in the following key areas:

  1. Health Education and Professional Development
  2. Information and Communications Technology Healthcare
  3. Medical Labs and Diagnostic Imaging Laboratories
  4. Standards and Accreditation of health professionals

In the initial term, the Centre will undertake Medical Lab Technician Training (with the Michener Institute in the lead); a Leadership and Management certificate program (York in lead); a Nursing professional development initiative (York in lead) and ongoing Research and evaluation (York in lead) on areas such as health system performance and safety, interprofessional teamwork, eHealth and health informatics.

A Lasting Impression

One of the most vivid memories from my trip to India was a visit to Jaipur Foot ( BMVSS (Bhagwan Mahaveer Viklang Sahayata Samiti) was set up in 1975 as a formally registered society in India. BMVSS is the largest organization in the world in fitting artificial limbs and calipers. The beauty of the Jaipur Foot is its lightness and mobility. Invented in 1968 by orthopedic surgeon Dr. Pramod Karan Sethi and an artisan Ram Chandra, the Jaipur Foot is sublimely low-tech – made from local material for the approximate cost of $28. It is provided free of cost to thousands of needy people.

I watched a craftsman (Ramnarain) shape a piece of aluminum into Jaipur Foot and fit it to a patient (Beharilal) in less than 45 minutes. Both Beharila and Ramnarain were superbly satisfied with the result. We can all learn much from this organization dedicated to helping people at the ‘bottom of the pyramid’.

BACKGROUNDER – York University and the Faculty of Health

York University is located in Toronto, Ontario. It is Canada's third-largest university and has produced several of the country's top leaders in the fields of health promotion, health sciences, chemical and space sciences, law, politics, management, literature, philosophy, journalism, and fine arts. York supports a student population of approximately 50,000 and staff of 7,000, as well as 200,000 alumni worldwide. It is home to 11 faculties, including the Schulich School of Business, Osgoode Hall Law School and the Faculty of Environmental Studies, as well as 23 research centres.

York University is very much committed to promoting interdisciplinary education and working towards expanding its boundaries of influence beyond the Canadian borders. Its Faculty of Health is dedicated to promoting Centres of Excellence in Healthcare and Health Promotion especially in the area of Public Health.

The Faculty of Health, established in 2006, has an ambitious mission to be an integrative force for promoting health – locally and globally. The Faculty consists of four integrated units encompassing Health Policy and Management, Kinesiology and Health Science, Nursing and Psychology. No university in Canada combines these strengths and perspectives in equivalent depth.

The Founding Dean of the Faculty of Health, Dr. Harvey Skinner, received graduate degrees in Psychology from the University of Western Ontario (PhD 1975; MA 1974); and Honors BA from McMaster University (1972). He is a Registered Psychologist in Ontario and a certified trainer in Motivational Interviewing. Previously, he was Professor and Chair of the Department of Public Health Sciences, Faculty of Medicine, University of Toronto. In September 2007 Dr Skinner was inducted as a Fellow of the Canadian Academy of Health Sciences.

Faculty members include renowned educators, researchers and policy makers dedicated to improving health promotion, disease prevention and health care. With over $7 million CDN per annum of externally-funded research grants, the faculty’s integrative research spans the continuum from the laboratory to the bed side to the community. The faculty has a strong complement of researchers including Tier One Canada Research Chairs, Distinguished Professors, Premier’s Research Excellence Awards recipients. Also, York University’s Faculty of Health supports numerous York on-campus research centres such as the Centre for Vision Research, York Institute for Health, LaMarsh Centre on Violence and Conflict Resolution, Milton & Ethel Harris Research Initiative on Child Development among others.

The Faculty of Health has almost 9,000 students and approximately 400 faculty members (177 full time; 227 part-time), and over 20,000 alumni from its previous host faculties.

Harvey A Skinner PhD, CPsych, FCAHS, is Dean, Faculty of Health, York University, Toronto. The Faculty is on an ambitious mission to be an integrative force for promoting health – locally and globally.

Canadian Centre of Excellence in Jaipur

An Indo-Canadian Collaboration
Andrew Holt

Health care is a global concern. World-wide growth in clinical and technical knowledge, pressures to meet the changing demand and expectations both locally and internationally, fragmentation of services and overwhelming cost burden have created many opportunities for international collaboration. Although there is widespread discussion at local, provincial and national levels little attention is being paid to systematically create collaborative international teams that draw on the inherent knowledge from diverse systems of medical practice, policy and governance, training strategies, professional licensing, funding and integrated systems for care delivery and observations made on the relationship between life style and susceptibility to diseases. The diversity of the ways in providing health care services offers many untapped opportunities for teams that collaborate across international boundaries to develop better treatment programs. Much remains to be learned through the organized and systematic sharing of care delivery strategies, methods, tools and bodies of knowledge. Collaborative models that draw from this vast intellectual and economic pool are an integral part of creating sustainable health care systems that will be effective, affordable and accessible over the long term.

The proposal to establish a Canadian Centre of Excellence by the Alpha Health Group, York University, and Michener Institute in Toronto, Canada in collaboration with the State of Rajasthan, India and the Rajasthan University of Health Sciences in Jaipur, is to work towards this goal. The Centre of Excellence will be at the forefront of technology and will focus on developing the following key areas:

  1. IT applied to Healthcare
  2. Medical Labs and Diagnostic Imaging Laboratories
  3. Accreditation and licensing
  4. Human Resource Development through Education, and training
  5. Applied research

Private and public sector resources from India and Canada will invest in the Centre of Excellence to ensure delivery of the best quality healthcare services in the following areas:
  • State of Art Medical and Diagnostic Imaging Laboratory services
  • Professional training and Continuing Education Technology School starting with Medical Laboratory Technology and Public Health Nursing School
  • Standards for Accreditation and licensing of Medical Laboratories, Hospitals, Nursing schools and other healthcare institutions in the State of Rajasthan
  • Electronic Medical Record
  • Electronic Document Management (including natural language extraction)
  • Other Software Products:
  • Electronic prescription ordering (to monitor pattern of use and also abuse by patients and ordering physicians)
  • Computer aided diagnosis and treatment
  • Evidence based medicine
  • Dynamic Scheduling of patients and optimization of resource allocation
  • Inter-disciplinary training environment for health professionals
  • Workflow Analysis
Other areas as required
  • The proposed Centre of Excellence for healthcare will apply the latest IT technology to health services and will collaborate in areas, such as:
  • Research: will focus on application of health informatics in healthcare, including tracking of infectious diseases and immunization status. Among the target research areas are evidence-based medicine, forecasting hospital needs and epidemics, biostatistic profiles, and monitoring quality of care. Alpha will also work with Rajasthan University of Health Sciences to facilitate the development and implementation of tele-medicine at the University teaching hospitals in Jaipur.
  • Education: this will include tools such as Alpha Computer Aided Diagnosis tool (Alpha CAD) to assist physicians and train medical students on the use of evidence-based medicine in diagnosis and treatment. Other areas of education will include medical schools and medical technology schools.
  • IT in Healthcare: Patient management IT tools will be made available in all 6 university teaching hospitals in Rajasthan (Globemed), clinics (UHM), and medical schools (Alpha CAD)
  • Accreditation and licensing: Alpha will provide international and national standards and facilitate the development of standards for accreditation and accreditation of healthcare institutions including diagnostic imaging, medical laboratories, hospitals, etc. where required.
  • Diagnostic Imaging and Medical Labs: a public-private partnership will be established to provide medical imaging and medical laboratory services to the University teaching hospitals and the private sector in Jaipur.

The Center of Excellence will provide state-of-the-art technology. Faculty from Rajasthan, York and Michener will use an inter- disciplinary team environment that integrates the latest e-health systems and evidence based clinical practices, to teach the students. Clinical and technical faculty could be augmented by professional faculty from areas such as engineering and international Masters in Business Administration to ensure graduating health professionals are properly trained to use the latest information systems in their team based clinical practices. Empowering health professionals to fully utilize information and knowledge management strategies is a vital skill required for life-long learning and the maintenance of competency throughout their professional career.

Experience gained at the Centre of Excellence would provide new insights into the provision of health care that could be shared internationally and contribute to the growth of quality health care within India and other countries. The International exchange of knowledge will bring together most relevant information into the clinical decision making process and training of new graduates. The Centre of Excellence will provide both India and Canada an opportunity to enhance the health services of Jaipur in the short term and will lay the foundation for a collaborative model with the potential for global impacts on health care practices over the longer term.


Corporate Profile
Alpha Healthcare Group

Alpha is a privately owned Canadian healthcare company founded in 1971 and is located in Toronto, Ontario Canada. The IT division of Alpha is engaged in developing Healthcare software including but not limited to, medical practice information systems.

Alpha Corporate Group has been serving the healthcare industry for over 37 years, providing state-of-the-art Medical and Diagnostic Imaging Laboratory Services, Industrial/Pharmaceutical Laboratory, and Managed-Care Medical Clinics. In addition, Alpha provides Electronic Medical Records and Practice Management Software for the healthcare professionals and institutions.

Alpha’s Research interest includes research in natural products, synthetic organic chemistry, physical chemistry, polymer chemistry, laboratory medicine and research and development of software systems to improve the efficiency, economy, and efficacy in treatment and management of diseases. Alpha is currently working with York University, Ottawa University, Dalhousie University and Waterloo University in Healthcare Related Research Projects to develop innovative solutions for care and treatment of patients and promoting healthy life style changes.

Andrew Holt is Vice President, Corporate Development, Alpha Health Group